<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<title>Insert title here</title>
</head>
<body>
<FORM ACTION="" METHOD="POST" NAME="testForm" ID="testForm">

<TABLE width="100%" ALIGN="CENTER" cellpadding=2 cellspacing=0
	BORDERCOLOR="#000000" BGCOLOR="#C0C0C0">

	<TR ALIGN="LEFT" VALIGN="TOP" BORDERCOLOR="#CCCCCC" height=21>

		<TD HEIGHT="1%" COLSPAN="2" ALIGN="RIGHT" VALIGN="TOP">Admin
		Controls:</TD>
		<TD HEIGHT="1%" ALIGN="LEFT"><INPUT NAME="cbxAdmin"
			TYPE="checkbox" ID="cbxAdmin"
			onClick="javascript:runAdmin(this.form);" VALUE="True"> Fill
		All fields</TD>

	</TR>

</TABLE>
<TABLE WIDTH="739" HEIGHT="0" border=1 ALIGN="CENTER" cellpadding=0
	cellspacing=0 CLASS="tblMain" ID="tblForm" DWCOPYTYPE="CopyTableCell">
	<!--DWLayoutTable-->
	<TR VALIGN="TOP">
		<TH COLSPAN="3" ALIGN="LEFT">Core Application Information</TH>
	</TR>

	<TR VALIGN="TOP">
		<TD WIDTH="28" ALIGN="LEFT" CLASS="tblRowNumber">1.</TD>
		<TD WIDTH="376" ALIGN="LEFT" VALIGN="TOP" CLASS="tblRowQuestion">Application
		Name:</TD>
		<TD ALIGN="LEFT" CLASS="tblRowField"><INPUT NAME="Q01_txtAppName"
			TYPE="text" CLASS="text" ID="_txtAppName" SIZE="40"></TD>
	</TR>

	<TR VALIGN="TOP">

		<TD ALIGN="LEFT" CLASS="tblRowNumber">2.</TD>

		<TD ALIGN="LEFT" VALIGN="TOP" CLASS="tblRowQuestion">Description
		of Application:</TD>

		<TD ALIGN="LEFT" CLASS="tblRowField"><TEXTAREA
			NAME="Q02_memoDescription" COLS="40" ROWS="4" WRAP="PHYSICAL"
			ID="Q02_memoDescription"></TEXTAREA></TD>

	</TR>

	<TR VALIGN="TOP">

		<TD ALIGN="LEFT" CLASS="tblRowNumber">3.</TD>

		<TD ALIGN="LEFT" CLASS="tblRowQuestion">Application URL:</TD>

		<TD ALIGN="LEFT" CLASS="tblRowField"><INPUT NAME="Q03_txtAppUrl"
			TYPE="text" ID="Q03_txtAppUrl" SIZE="40"></TD>

	</TR>

	<TR VALIGN="TOP">

		<TD ALIGN="LEFT" CLASS="tblRowNumber">5.</TD>

		<TD ALIGN="LEFT" CLASS="tblRowQuestion">What is your business
		organization?</TD>

		<TD ALIGN="LEFT" CLASS="tblRowField"><SELECT
			NAME="Q05_lstBusiness" ID="Q05_lstBusiness">

			<OPTION SELECTED>[select one]</OPTION>

			<OPTION VALUE="Corp">Corp</OPTION>

			<OPTION VALUE="ESG">ESG</OPTION>

			<OPTION VALUE="IPG">IPG</OPTION>

			<OPTION VALUE="PSG">PSG</OPTION>

			<OPTION VALUE="HPS">HPS</OPTION>

		</SELECT></TD>

	</TR>

	<TR VALIGN="TOP">

		<TD ALIGN="LEFT" CLASS="tblRowNumber">6.</TD>

		<TD ALIGN="LEFT" CLASS="tblRowQuestion">Which region(s) does the
		site serve?</TD>

		<TD ALIGN="LEFT" CLASS="tblRowField"><SELECT NAME="Q06_lstRegion"
			ID="Q06_lstRegion">

			<OPTION SELECTED>[select one]</OPTION>

			<OPTION VALUE="Asia Pacific">Asia Pacific</OPTION>

			<OPTION VALUE="EMEA">EMEA (Europe, Middle East, Africa)</OPTION>

			<OPTION VALUE="Latin Americas">Latin Americas</OPTION>

			<OPTION VALUE="North Americas">North Americas</OPTION>

		</SELECT></TD>

	</TR>

	<TR VALIGN="TOP">

		<TD ALIGN="LEFT" CLASS="tblRowNumber">7.</TD>

		<TD ALIGN="LEFT" CLASS="tblRowQuestion">What type of user does
		the site serve</TD>

		<TD ALIGN="LEFT" CLASS="tblRowField">
		<TABLE WIDTH="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0"
			CLASS="tblYesNo" ID="tblQ09">

			<TR height=21>

				<TD NOWRAP><INPUT NAME="Q09_cbx1hho" TYPE="checkbox"
					ID="Q091_cbxHHO" VALUE="Home & Home Office"> Home & Home
				Office</TD>

				<TD NOWRAP><INPUT NAME="Q09_cbx2smb" TYPE="checkbox"
					ID="Q091_cbx2" VALUE="Small & Medium Office"> Small &
				Medium Office</TD>

			</TR>

			<TR height=21>

				<TD NOWRAP><INPUT NAME="Q09_cbx3gov" TYPE="checkbox"
					ID="Q09_cbx3gov" VALUE="Government & Education"> Government
				& Education</TD>

				<TD NOWRAP><INPUT NAME="Q09_cbx4int" TYPE="checkbox"
					ID="Q09_cbx4int" VALUE="Internal Employee"> Internal
				Employee</TD>
			<TR height=21>

				<TD NOWRAP><INPUT NAME="Q09_cbx5ent" TYPE="checkbox"
					ID="Q09_cbx5ent" VALUE="Enterprise"> Enterprise</TD>

				<TD NOWRAP><INPUT NAME="Q09_cbx6prt" TYPE="checkbox"
					ID="Q09_cbx6prt" VALUE="Partners & Developers"> Partners &
				Developers</TD>
			<TR height=21>

				<TD COLSPAN="2" NOWRAP>?</TD>
		</TABLE>
		</TD>

	</TR>

</TABLE>

</FORM>
</body>
</html>